UNICEF UK calls for more support for mothers

Research commissioned by UNICEF UK reveals that low breastfeeding rates in the UK are costing the NHS millions of pounds.

The report takes an in-depth look at how raising breastfeeding rates would save money through reducing illness. Calculations from a mere handful of illnesses, where the evidence is strongest, show that moderate increases in breastfeeding could see potential annual savings to the NHS of approx £40m per year.

However, this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account.

For diseases where evidence was strongest, the authors produced quantitative economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterecolitis (NEC) in the baby), showing how moderate increases in breastfeeding would translate into cost savings for the NHS:

If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:

  • 865 fewer cases of breast cancer
  • With cost savings to the NHS of over £21million
  • Improved quality of life equating to more than £10million[1]
  • Over the lifetime of each annual cohort of first-time mothers.

If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfed at discharge, each year there would be:

  • 3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million
  • 5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million
  • 21,045 fewer GP visits for ear infection, saving £750,000
  • 361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million

Breastfeeding protects babies and mothers against many illnesses. Improving care in the NHS has led to more women starting to breastfeed, but care is still patchy and a lack of support across society means that many breastfeeding mothers encounter problems which can cause them to stop before they want to.

“We know that 90% of women who stop breastfeeding in the first six weeks discontinued before they had wanted to,” said UNICEF UK Deputy Executive Director Anita Tiessen

“As a society we are failing mothers and babies, and this new report shows that low breastfeeding rates in the UK are costing the NHS millions of pounds each year – as well as causing untold distress and suffering for families.

“We want to see breastfeeding recognised as a major public health issue from government level through to local children’s centres, and appropriate investment and legislation put in place to give mothers a better experience of breastfeeding. The good news for commissioners, planners and decision makers is that our research shows that money invested to help women breastfeed for longer would provide a rapid financial return.”

She added: “Enabling women to breastfeed for as long as they choose is a health issue where the interests of the mother, baby and health service all align.”

The report, entitled Preventing Disease and Saving Resources: potential contribution of increasing breastfeeding rates in the UK, was carried out by a  multi-university academic team including Dundee University, Oxford University,  University of York, Brunel University, and St George’s, University of London, as well as the National Childbirth Trust.

Because data around the protective effects of breastfeeding is not always collected at the level of detail needed, the team identified four categories of diseases or conditions with different levels of evidence currently available (For detailed findings see below). Reliable costs could only be modelled for a handful of the many illnesses where breastfeeding is thought to have a protective effect, so the figures are likely to be a fraction of the potential savings.

It is clear – even taking a conservative view - that investing in services to support women to breastfeed for longer would provide return on investment within a few years, possibly as little as one year.  Higher breastfeeding rates would yield greater savings.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE (National Institute for Health and Clinical Excellence), who wrote the Foreword for the report, stated: “This report makes refreshing reading.

“The authors present an argument which in a nutshell promises to make considerable savings for the health services, produce long run health benefits and is a mechanism for changing the differences in health outcomes across social groups.  The idea is of course simplicity itself; improving the rates of the initiation and the continuation of breastfeeding.”

Professor Mitch Blair, Officer for Health Promotion at the Royal College of Paediatrics and Child Health, said: "The RCPCH recognises the important contribution breastfeeding can make to the health of mothers and children in the short and long term. It recognises the need to promote and invest in services which aim to support all mothers so that they can breastfeed as long as is desirable."

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For more information on the report, or to request an interview, please contact Sarah Vincent on 020 7375 6097, mb 07814 447935, or the UNICEF UK Media Relations office on 020 7375 6030. Or email sarahv@unicef.org.uk.

Findings

Note: All the figures and targets below apply to shifts in the behaviour of the UK population, and do not apply to each woman. What an individual mother needs to know is that any breastfeeding will provide some protection against illness, and more breastfeeding will provide a bigger  protective effect.

 

For the first category of illnesses, where evidence was strongest, the authors produced quantitative economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterecolitis (NEC) in the baby), showing how moderate increases in breastfeeding would translate into cost savings for the NHS:

 

  • If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:

-         865 fewer cases of breast cancer

-         With cost savings to the NHS of over £21million

-         Improved quality of life equating to more than £10million[2]

Over the lifetime of each annual cohort of first-time mothers.

 

  • If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfed at discharge, each year there would be:

-         3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million

-         5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million

-         21,045 fewer GP visits for ear infection, saving £750,000

-         361 fewer cases of the potentially fatal disease NEC, saving more than £6million

 

 

For the second category of conditions where the evidence was good but not strong enough to run full economic models, the authors conducted narrative analyses on three conditions - cognitive ability, childhood obesity and Sudden Infant Death Syndrome - to predict the likely impact of increasing breastfeeding rates. They estimate that:

 

  • If the number of babies receiving any breastmilk at all rose by 1% this could lead to a small increase in IQ, which across the entire population could result in more than £278 million gains in economic productivity annually[3]
  • A very modest increase in exclusive breastfeeding rates could lead to at least three fewer cases of Sudden Infant Death Syndrome annually, saving around £4.7 million in monetary costs, and more importantly avoiding the profound consequences for families
  • Increasing breastfeeding rates could lead to around a 5% reduction in childhood obesity, which would save around £1.6million each year.

 

In the third category are illnesses where research indicates it is plausible or likely that breastfeeding reduces incidence, but where the evidence is not in the form required to model reliably; for example, although raised blood pressure and cholesterol levels in childhood are markers of future adult cardiac disease that are related to not being breastfed, it is not possible to calculate the costs of cardiac disease based on these markers alone.

Significantly, the list contains diseases which severely affect quality of life and which are responsible for a significant bulk of the NHS budget, so if it were possible to reduce these illnesses through breastfeeding – even by only 1-2% - it would have a considerable economic impact.

The list of illnesses in this category include: diabetes (Type 2 for mothers and mainly Type 1 for children), cardiovascular disease, ovarian cancer, asthma, leukaemia, coeliac disease, and neonatal sepsis.

More research is urgently needed to establish how significant a role breastfeeding could play in reducing the incidence of major chronic diseases.

The fourth category identified a list of 45 conditions where there is some evidence of breastfeeding providing protection, but where the authors considered current data unreliable. This list also forms an agenda for future research.

Professor Mary Renfrew, from Dundee University, who led the group, said: “This research shines a spotlight on the profound protective effects which breastfeeding has on both mother and child.

“It shows that the NHS could save money in different ways, both from the immediate costs of treating acute infant diseases, and longer term savings from reduced incidence of breast cancer. Larger scale savings from chronic diseases are also likely, although the evidence was not in form required for calculating costs. There would also be considerable health gains for both mothers and babies.

“It is clear that putting resources into supporting women to breastfeed successfully would be hugely cost effective to the NHS, as well as preventing the distress and pain felt by a mother who has a bad experience of breastfeeding.”

Next steps

The UK has one of the lowest breastfeeding rates in the world, particularly in terms of duration of breastfeeding.

The percentage of mothers initiating breastfeeding is 81% across the UK (2010 data) (83% in England, 74% Scotland, 71% in Wales, 64% Northern Ireland). These initiation rates have been rising over the past decade, largely driven by improvements in care across the NHS.

However, rates of breastfeeding at 6-8weeks remain worryingly low, with 90% of mothers who discontinue breastfeeding saying they stopped before they wanted to. We are expecting new 2010 data (from the five yearly Infant Feeding Survey) for continuation rates in the next couple of months, but until then the best we have is 2005 data which shows that in the UK only 48% of babies were getting any breastmilk at six weeks, and only 25% were getting any at six months.

Less than 2% of babies were being exclusively breastfed at six months, despite advice from the Department of Health, along with WHO and UNICEF, that babies should be exclusively breastfed for around the first six months of life.

“The fact that so few babies are being exclusively breastfed at six months – despite all the evidence showing this to be the healthiest option - is an indication of how difficult it is for mothers in the UK to choose breastfeeding as the sole means of feeding their baby,” said UNICEF UK Baby Friendly Director, Sue Ashmore.

“In order to remove some of the barriers that prevent women from successfully breastfeeding we need a change of approach throughout society. We want breastfeeding to become unremarkable, something that we see mothers doing all around us every day, so that breastfeeding skills are passed on socially.

“But we also need to ensure that the health services are fit for purpose, by ensuring that breastfeeding remains a priority for action, that there are properly staffed support services for breastfeeding mothers.”

Specifically, UNICEF UK is calling for:

  • Leadership from government and policy makers recognising breastfeeding as a major public health issue
  • Breastfeeding to be a priority action for all Health and Wellbeing Boards at national and local level, and the equivalent bodies in devolved governments
  • Sufficient levels of well qualified staff in the NHS
  • Consistently good quality support services to enable mothers to breastfeed for as long as they want to
  • Campaigns to make people aware of the extensive health benefits of breastfeeding
  • Legislation to tighten the law and prevent formula companies undermining breastfeeding
  • Urgent research into how breastfeeding helps protect against some of the big killers like heart disease and diabetes.

For more information on the report, or to request an interview, please contact Sarah Vincent on 020 7375 6097, mb 07814 447935, or the UNICEF UK Media Relations office on 020 7375 6030. Or email sarahv@unicef.org.uk.

Notes:

●  The Baby Friendly Initiative works with the health-care system to ensure a high standard of care in relation to infant feeding for pregnant women and mothers and babies. Support is provided for health-care facilities that are seeking to implement best practice, and an assessment and accreditation process recognises those that have achieved the required standard.

[1] This figure was calculated using the standard measure of quality-adjusted life years (QALYs) ; the benefit is to the individual

[2] This figure was calculated using the standard measure of quality-adjusted life years (QALYs) ; the benefit is to the individual

[3] This is a standard measure and is calculated over the lifetime of each annual cohort